HomeMy WebLinkAbout621 WOOD ST - MISCELLANEOUS - 4/23/2001Building
&Zoning
Dept.
281 N. College Avenue, P.O. Box 580
Fort Collins,
Community Planning and Environmental Services
Colorado 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
HOME OWNER -BUILDER AFFIDAVIT
(PLEASE PRIM
I/We,
B0102251
_, as owner(s) of record of the Qproperty
located at:
e�� <-e �` y Fort Collins, Colorado, hereby declare and attest
to the following:
I am/we are acting on my/our behalf for the purpose of obtaining a building permit for the construction
or alteraltion of my/our home. The home to be constructed or altered is on the above property and
is my/our personal residence.
2. 1 am/we are personally performing all of the work, or supervising unpaid volunteers or "employees' (see
PPM 58 attached) who might be assisting with any of the work related to the construction of the above -
referenced home, which is described more fully on Permit Application No. (obtain from
Building & Zoning Office).
3, I/we have not personally constructed any other new home within the past 12-month period.
4. I/we understand that any persons or agents contracted to perform structural framing, plumbing, HVAC,
electrical work, or roofing, MUST BE licensed contractors in accordance with the regulations of Fort
Collins.
5. I/we understand that failure to comply with any of the above conditions may result in revocation of any
permits associated with the above Application Number, and forfeiture of any fees that have been
collected.
Owner
STATE OF COLORADO )
)SS.
COUNTY OF LARIMER )
Owner
The foregoing Affidavit was acknowledged before me this �_ day of
�, by Z�ia,lda_
Witness my hand and official seal.
My Commission expires:
My Commission Expires November 10, 2002